Non-Invasive Prediction of High-Risk Varices in Patients with Primary Biliary Cholangitis and Primary Sclerosing Cholangitis

Carlos Moctezuma-Velazquez, Francesca Saffioti, Stephanie Tasayco-Huaman, Stefania Casu, Andrew Mason, Davide Roccarina, Victor Vargas, Jan Erick Nilsson, Emmanuel Tsochatzis, Salvador Augustin, Aldo J. Montano-Loza, Annalisa Berzigotti, Douglas Thorburn, Joan Genesca, Juan Gonzalez Abraldes

Research output: Contribution to journalArticleResearch

23 Citations (Scopus)

Abstract

© 2018 by The American College of Gastroenterology. BACKGROUND:Baveno-VI guidelines recommend that patients with compensated cirrhosis with liver stiffness by transient elastography (LSM-TE) <20 kPa and platelets >150,000/mm3 do not need an esophagogastroduodenoscopy (EGD) to screen for varices, since the risk of having varices needing treatment (VNT) is <5%. It remains uncertain if this tool can be used in patients with cholestatic liver diseases (ChLDs): primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). These patients may have a pre-sinusoidal component of portal hypertension that could affect the performance of this rule. In this study we evaluated the performance of Baveno-VI, expanded Baveno-VI (LSM-TE <25 kPa and platelets >110,000/mm3), and other criteria in predicting the absence of VNT.METHODS:This was a multicenter cross-sectional study in four referral hospitals. We retrospectively analyzed data from 227 patients with compensated advanced chronic liver disease (cACLD) due to PBC (n = 147) and PSC (n = 80) that had paired EGD and LSM-TE. We calculated false negative rate (FNR) and number of saved endoscopies for each prediction rule.RESULTS:Prevalence of VNT was 13%. Baveno-VI criteria had a 0% FNR in PBC and PSC, saving 39 and 30% of EGDs, respectively. In PBC the other LSM-TE-based criteria resulted in FNRs >5%. In PSC the expanded Baveno criteria had an adequate performance. In both conditions LSM-TE-independent criteria resulted in an acceptable FNR but saved less EGDs.CONCLUSIONS:Baveno-VI criteria can be applied in patients with cACLD due to ChLDs, which would result in saving 30-40% of EGDs. Expanded criteria in PBC would lead to FNRs >5%.
Original languageEnglish
Pages (from-to)446-452
JournalAmerican Journal of Gastroenterology
Volume114
DOIs
Publication statusPublished - 1 Mar 2019

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